Avoiding the travel hassles of initial respiratory assessments

Imagine struggling for each breath, but facing a lengthy and possibly costly journey just to get a quick assessment on your chances of relief.

For patients with respiratory illness like Chronic Obstructive Pulmonary Disease (COPD), that initial assessment to see if you’re a candidate for rehab can bring a whole set of ordeals. For those living in isolated communities, it might mean taking a day or two off work to travel to where the rehab program is located. Add in the cost of travel, or headaches with parking or navigating unfamiliar territory, and the ordeal can be overwhelming.

Wouldn’t it better if you could just stay within your own community and do a live assessment via the internet – allowing you to avoid all those travel hassles?

That’s what West Park Healthcare Centre in west Toronto has been researching – using an initial teleconsultation for some respiratory patients who live outside the city.

“It might be a plane ride to get here, and then you get a 45-minute consultation,” says Sachi O’Hoski, a West Park physiotherapist and one of the researchers involved in the study. “It’s the conversation that’s really important, and it can just as easily be completed with a teleconsultation.”

The study, recently published in the Canadian Journal of Respiratory, Critical Care and Sleep Medicine, examined nearly 100 cases between 2012 and 2015 where the initial assessment was completed via the Ontario Telehealth Network (OTN). Nearly half the patients lived between 400 km and 800 km away from the hospital.

A local coordinating healthcare professional (most commonly a nurse or respiratory therapist) joined the patient and any family members for the teleconsultation. The focus of the interview was the discussion of the functional and emotional impact of the disease, provision of information about what pulmonary rehabilitation entails and discussion of the patients’ motivation to improve.

The study concluded that teleconsultation is an alternative to in-person clinic visits, and may be effective in reducing travel costs for patients and improving their access to specialty respiratory consultation.

The Ontario patients involved in the study saved a total of 70,070 km in travel, which translates to a travel-only cost savings of $28,028. “The most important thing is this is a way we can get a good picture of the health challenges of the person, and it saves people a lot of travel and money,” says O’Hoski.

One patient from Elliott Lake in Northern Ontario was the first teleconsultation. She was so happy with the teleconsultation process that she recruited others with lung problems in her community to participate, says O’Hoski.

The teleconsultation also gives the chance to explain the program, answer any questions, as well as make an informed assessment. “It doesn’t have to be in person,” she says.

Dr. Roger Goldstein, who heads Respiratory Services at West Park, is optimistic about using live video consultations for both initial assessment as well as after-program follow-ups. “This approach is working well. It might also lead to an opportunity to promote education and exercise at a distance provided there are some locally trained staff at the satellite site” says Dr. Goldstein.

Respiratory patient Kim Verwaayen travelled for more than two hours from London to get to her initial assessment at West Park. The anxiety could have been overwhelming, yet the prospect of finally qualifying for a respiratory rehabilitation program to get her life back made it all worthwhile, she says. A teleconsultation would have been a great way to ease into the pulmonary rehabilitation program, says Verwaayen.

“For some folks, summoning up enough energy to travel on top of everything else you have to do, can be too much,” she says. “To be able to conserve that energy and to have that conversation in the easiest way possible is great for sick people.”

Now that Verwaayen’s graduated from the inpatient program and has returned to London, she can see further benefits of staying in touch via teleconsultation as needed, without having to leave her own community.

Vince Rice is Director of Public Relations at West Park Healthcare Centre.